| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,953 |
1,094 |
$59K |
| D1999 |
|
3,293 |
1,789 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
1,812 |
996 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,069 |
589 |
$26K |
| D0330 |
Panoramic radiographic image |
748 |
408 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,288 |
703 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,223 |
646 |
$19K |
| D1120 |
Prophylaxis - child |
843 |
459 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
113 |
33 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
29 |
12 |
$3K |